1. Dr. Jacob Meyer Veloz CCRMC Family Medicine Resident

2.  Peru’s poorest province  Mining and Agriculture  Spanish and Quechua spoken

3.  Isolated province of Huancavelica  Population of approximately 30,000  Near VRAE  3262 meters above sea level

4. 19962006 Infant mortality43 per 100021 per 1000 Prenatal care67%91% Births attended by professionals 56%71% Maternal mortality 421/100,000185-240/100,000

7.  Hemorrhage  Preeclampsia  Infeccion  Complications of abortion  Obstructed labor  27% prenatal, 26% peripartum, 46% up to 6 weeks post-partum

8.  Amnesty International says: Eliminate obstacles that impede or slow women’s access to urgent obstetric services  Barriers Geographic, economic, cultural, professional,

10.  Reduce maternal mortality to 120/100,000

19.  Intercultural care Vertical birth  Intermittent monitoring  Health Center Care

21.  Malnutrition  Iron Deficiency  Parasitosis  Respiratory infection

23.  Respiratory infections  Perinatal disease  Accidents  Congenital diseases  Malnutrition

28.  Iron deficiency Anemia  Vitamin A deficiency  Protein deficiency  Vitamin C deficiency  Vitamin B12 deficiency

29.  Falling of growth curve  Muscular atrophy  Slowed motor, psychologic and language developement  Dry and peeling skin  Fissures on face, lips  Frequent respiratory tract infections  Lightened hair color  Tachycardia  Delayed puberty

32.  More conservative with antibiotics  Clinical diagnosis of vitamin deficiencies based on risk factors and prevalence in provinces  Provide vitamins to nearly all children in village  Low threshold to treat for parasites

33.  64.6% prevalence in Huancavelica  Dietary deficiency  Normal hemoglobin 2 points higher at altitude

34.  Village outreach  Clinical Diagnosis  Provide iron supplements to nearly all children

37.  Giardia lamblia  Ascaris lumbricoides  Entamoeba histolytica  Taenia solium  Taenia sanginata  Primary biologist reports prevalence of up to 80% among children of Churcampa

38.  Approximately 30% of O & P done positive  Asymptomatic  Abdominal pain  Abdominal obstruction  Hemoptysis  Compounds problems of malnutrition

40.  Albendazole 400mg po x 1  Mebendazole 100mg po BID x 3 days  Treat family  Encourage clean water  Other options: Pyrantel pamoate Ivermectin

41.  30-40% of children with stool sample positive  Water supply contaminated  As few as 10 cysts can cause infection

43.  Diarrhea  Abdominal cramps or tenderness.  Nausea and loss of appetite.  Passing more gas or having more bloating than usual.  Fatigue.

45.  Loose, soft, greasy stools (not always watery or liquid). Sometimes the stools may be foul-smelling or foamy and are often passed in small amounts.  Discomfort in the abdomen or pit of the stomach that is often worse after a meal.  Belly cramps, bloating, or pain.  Passing more gas than usual.  Persistent bad breath or belching that sometimes smells of sulfur  Occasional headaches.  Weight loss.  General feeling of discomfort or illness (malaise), weakness, or fatigue. Web MD

46.  Pale, foamy, foul-smelling diarrhea.  Weight loss or lack of appetite.  Belly pain, nausea, or vomiting.  Nutritional deficiencies caused by not being able to absorb certain nutrients.

47.  Failure to thrive  Iron deficiency anemia  Protein malnutrition  Malabsorbtion of; Fat D-xylose Vitamin A Vitamin B12 Giardia intestinalis and nutritional status in children PARTICIPATING INTHEcomplementary nutrition program, Antioquia, Colombia, May to October 2006

48.  Metronidazole 25mg/kg divided TID  Consider treating for other parasites  Side effects: nausea & vomiting  Jacob’s Treatment Metronidazole 250mg po TID x 5 days  Other options: Furazolidone 100mg po QID x 7-10 days Albendazole

51.  Maternal mortality improving thanks to culturally sensitive care  Infant mortality improving  Malnutrition still large problem  Peruvian health system making changes but much work to be done